Utility of Extracorporeal Membrane Oxygenation for Graft Failure After Pediatric Heart Transplantation in the Unites States: Analysis of Organ Procurement and Transplant Network Database and Extracorporeal Life Support Organization Registry

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used for years to support children with severe graft failure after heart transplantation; however data on outcomes are limited. We sought to characterize outcomes for children supported with ECMO after heart transplantation in the US using a large national database. All children <16 years of age supported with ECMO after heart transplantation between 1988 and 2009 were identified using data combined from the Organ Procurement and Transplant Network database and the Extracorporeal Life Support Organization Registry. Long term survival was compared between patients supported for early (<72 hours post transplant) versus late graft failure. Of 226 children who met the inclusion criteria, the median age at the time of ECMO support was 13 months (IQR: 4 mo to 8.2 years). The median time from transplant to ECMO was 1 day (range: 0 to 12.5 years); 138 (61%) were supported for early graft failure whereas 80 (39%) for late graft failure. While there was trend toward longer ECMO support times for late graft failure compared to early graft failure (4.7 days versus 3.6 days, P=0.07), children supported with ECMO for early graft failure had significantly better survival on ECMO (72% versus 57%, P=0.03) and were significantly more likely to survive to hospital discharge (54% versus 32%, P=0.002). Overall, 55% of children supported with ECMO failed to survive to hospital discharge. ECMO has been used frequently to support children with graft failure following heart transplant. While children supported for primary graft failure have better survival than children supported for late graft failure, more than half of all children died prior to hospital discharge. More effective circulatory support options are needed for the treatment of graft failure with hemodynamic compromise.